Provider Demographics
NPI:1689699068
Name:COLE, GREGORY PHILLIP (DDS)
Entity Type:Individual
Prefix:DR
First Name:GREGORY
Middle Name:PHILLIP
Last Name:COLE
Suffix:
Gender:M
Credentials:DDS
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1560-1 NEWBURY RD # 334
Mailing Address - Street 2:
Mailing Address - City:NEWBURY PARK
Mailing Address - State:CA
Mailing Address - Zip Code:91320-3448
Mailing Address - Country:US
Mailing Address - Phone:805-953-5224
Mailing Address - Fax:
Practice Address - Street 1:1560-1 NEWBURY RD # 334
Practice Address - Street 2:
Practice Address - City:NEWBURY PARK
Practice Address - State:CA
Practice Address - Zip Code:91320-3448
Practice Address - Country:US
Practice Address - Phone:805-953-5224
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2006-07-13
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA27258122300000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes122300000XDental ProvidersDentist